Provider Demographics
NPI:1699040147
Name:LEIBOWITZ, ZOE (PSYD)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:LEIBOWITZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E ERIE ST # 525-4535
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2740
Mailing Address - Country:US
Mailing Address - Phone:773-706-2815
Mailing Address - Fax:872-278-0660
Practice Address - Street 1:1 E ERIE ST # 525-4535
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2740
Practice Address - Country:US
Practice Address - Phone:773-706-2815
Practice Address - Fax:872-278-0660
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 103TF0200X
IL071-009681103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic